title: Healthcare professionals' perspectives on environmental sustainability.
abstract: BACKGROUND
  Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions.
  
  
  OBJECTIVE
  What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome?
  
  
  METHODS
  Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines.
  
  
  METHODS
  A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited.
  
  
  METHODS
  Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity.
  
  
  RESULTS
  Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector's focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties.
  
  
  CONCLUSIONS
  The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour.
  
  
  CONCLUSIONS
  The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to shift to environmentally responsible practice without support from institutions and professional associations. Professional development is required to support this endeavour. The poor transference of pro-ecological behaviour from one setting to another is likely to have international implications for healthcare practice.
authors.affiliation: Charles Sturt University, Australia jidunphy@csu.edu.au.
authors.forename: Jillian L
authors.initials: JL
authors.lastname: Dunphy
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003247:Conservation of Natural Resources; D004782:Environmental Health; D005260:Female; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012933:Social Identification
keywords: Environmental sustainability; healthcare ethics; professional paradigms; social identification